Weekly Case Study - Case 2

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Twenty-four year-old graduate student goes to the funeral of her professor. During the eulogy, she suddenly develops these symptoms.

Weakness in both legs, dizziness, light-headedness, tinnitus, visual blurring, and nausea. She then "passes out" and is observed to be briefly rigid and to have irregular myoclonic jerks of the left hand and right foot. She rapidly regains consciousness without any post-event confusion. She has no headache, muscle pain or incontinence. EMS takes her to the ED and she is admitted with diagnosis of vertebral basilar TIA. She is neurologically normal 30 minutes after the episode.
  1. Do you agree with this diagnosis?

  2. Offer potential alternative diagnosis, which might be more consistent with symptoms.

  3. What diagnostic tests should be done for this patient?

  4. Assume that the EEG shows "bitemporal sharp waves", would this suggest an alternative diagnosis?

  5. Assume that the episode was preceded by throbbing headaches and her neck was sore after the episode and headache persisted after she awakened from the loss of consciousness.

    6. a. What diagnosis would you suggest?
    b. What tests should be done?

  6. Define these terms:
    7. seizure
    convulsion
    epilepsy
    pseudo-seizure
    hysterical seizure
    psychogenic seizure
    convulsive syncope

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no films rev. 3/16/04